Provider Demographics
NPI:1700121340
Name:VA HEALTH CARE SYSTEMS
Entity Type:Organization
Organization Name:VA HEALTH CARE SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MICHIE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:203-927-4242
Mailing Address - Street 1:19 TALMADGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1724
Mailing Address - Country:US
Mailing Address - Phone:203-758-4154
Mailing Address - Fax:
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9764
Practice Address - Country:US
Practice Address - Phone:413-582-3146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029733283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital